Michael Liu grew up in Toronto, Canada, then moved to the US for college and medical school because, for him, the US was the prime destination to fulfill his aspirations of becoming a physician and researcher.
“You know, chasing the American dream, and understanding all the opportunities – that was a fascination for me,” says Liu, who attended Harvard University. He is now 28 and has deep personal and professional roots in Boston, where he is an internal medicine resident at Mass General Brigham.
But this spring, he was shaken by the Trump administration’s cuts to scientific research at the National Institutes of Health and staff at the Department of Health and Human Services. “That was a really amazing moment for me,” Liu says. “It made me question where it mattered most to me professionally. I still have strong ties to Toronto and the bosses.”
Then, in September, Liu was traveling with two doctors to Mexico and Costa Rica when the administration raised fees nearly 30 times for H1B visas, which are for highly trained professionals, to $100,000. She witnessed her coworkers’ tearful reactions to the sudden uncertainty over their careers, knowing that employers like hospital systems were unlikely to be able to pay for such a dramatic increase.
“It was terrifying to watch,” Liu says. He has a green card and married a US citizen earlier this year. But he says the actions of the Trump administration affect him.
“It feels as if my contribution – just because I wasn’t born in this country – is less valuable,” Liu says. “I hadn’t really thought that deeply about moving back home before, but it’s definitely been on my mind a lot.”
a rural workforce
Nearly a quarter of all doctors in the country are immigrants, and the American health care system relies heavily on them. There are approximately 325,000 physicians – No This includes nurses or other critical health care workers – those living and working in the US who were born and trained elsewhere.
In rural communities, and in some subspecialties of medicine, reliance on immigrant physicians is high. For example, in specialties such as primary care and oncology, foreign-born doctors make up almost half of the workforce.
Meanwhile, health care is already burdened by retirements and burnout. Many experts say recent immigration and health policies are making it harder and less attractive for foreign-born talent to bolster the understaffed U.S. health system.
“Right now is a critical moment where decades of progress could be at risk,” says Dr. Julie Gralow, chief medical officer of the American Society of Clinical Oncology.
She says policies funding everything from scientific research to public health have damaged America’s reputation to such an extent that she hears from hospitals and universities that top international talent is no longer interested in coming to the US. “Up until this year, it was a dream—a wish!—that you could get a job and come to America and now nobody wants to come.”
Meanwhile, other countries like China, Denmark, Germany and Australia are taking advantage by recruiting international talent away from the U.S. — including American-born doctors and medical researchers — by promising stable grant funding and state-of-the-art facilities abroad, Gralow says.
Gralow says American patients will feel the effects for generations.
Boston Medical Resident Michael Liu says immigrant physicians have historically found jobs in U.S. communities that had severe health care workforce shortages to begin with, so those places may also see a greater impact from fewer international hires.
He points to recent research he co-authored in JAMA that estimated that 11,000 doctors, or about 1% of the country’s physicians, currently hold H1B visas. “This may seem like a small number, but this percentage varies widely in different geographic areas,” he said, and they tend to cluster in the least resourced areas, reaching as high as 40% of physicians in some communities.
“The prevalence of H1B physicians was four times higher in high-poverty countries; we saw the same pattern in rural communities,” he says. (Many physicians and physician residents may have different types of visas, such as J1B, and others.)
Groups like the American Medical Association have asked the administration to exempt physicians from the new H1B fees. HHS did not respond to requests seeking comment about recent visa policies and health care workers, However some of the opposition has softened the president’s position.
Immigration history
For the past six decades, immigrants have contributed enormously to America’s reputation as the undisputed world leader in health research and practice. In pay and prestige, the US has been unique, helping to attract the world’s best talent at the expense of their home countries.
It began in 1965 during a period of expanding federal investment in public health and scientific research, driven by international competition and Cold War rivalry over events such as the Soviet launch of Sputnik. That year, Medicare and Medicaid were created, and with them, the demand for doctors suddenly increased, says Iram Alam, a professor of science history at Harvard.
“Overnight, you have 25 million – almost – people who can now access health care services,” Alam says. Passage that year of the Hart-Celler Immigration and Nationality Act opened U.S. borders to doctors and others with in-demand skills, says Alam, who recently published a book. care of foreignersAbout the history of immigrant physicians in America.
Over the next decade, the US granted visas to 75,000 physicians, and by 1975, about 45% of all US doctors were immigrants, Alam says. America’s first-class reputation allowed it to attract more physician talent than the US could educate and train: “There were more immigrant physicians entering the labor force per year than physicians trained in the US,” she says.
Now, Alam says, the US is eliminating much of this as it erodes its global leadership role in medicine and science, and closes its borders.
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